FELLOW'S  PAMPHLETS 


MODERN  ANTISEPTIC  SURGERY 


AND  THE  ROLE  OF  EXPERIMENT  IN  ITS  DISCOVERY 
AND  DEVELOPMENT 


^Y.    W.     KEEN,     M.D.,    LL.D. 

PHILADELPHIA 


DEFENSE    OF    RESEARCH 
PAMPHLET    XII 

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CHICAGO 

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1913 


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AMERICAN    MEDICAL    ASSOCIATION 

53S   NORTH  DEARBORN  STREET,  CHICAGO 


MODERN  ANTISEPTIC  SURGERY 


And  the  Role  of  Experiment  in  Its  Discovery  and 
Development 


W.     W.     KEEN,     M.D.,    LL.D. 

PHILADELPHIA 


/ — 


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MODEBN   ANTISEPTIC    SUKGERY 

AND    THE   ROLE   OF   EXPERIMENT    IN    ITS   DISCOVERY   AND 
DEVELOPMENT 


W.  W.  KEEN,  M.D.,  LL.D. 

PHILADELPHIA 


The  subject  naturally  divides  itself  into  three  parts: 
(1)  the  conditions  before  the  introduction  of  the  anti- 
septic method  by  Lister;  (2)  the  means  by  which  his 
system  was  discovered  and  developed,  and  (3)  the  con- 
ditions existing  after  the  introduction  of  the  method, 
i.  e.,  at  the  present  time. 

My  surgical  life  covers  all  three  of  these  periods  since 
I  graduated  in  medicine  in  1862,  some  years  before  Lis- 
ter began  his  work.  I  have,  therefore,  fought  my  way 
from  the  horrors  of  the  preantiseptic  days  up  to  the 
delights  of  the  present  antiseptic  days.1 

I.    THE  PREANTISEPTIC  PERIOD 

In  my  early  surgical  experience  every  accidental 
wound  and  every  surgical  operation  (that  is,  an  inten- 
tional wound)  was  followed  by  inflammation  and  sup- 
puration, i.  e.,  the  discharge  of  "pus"  or  "matter."  This 
was  not  only  constantly  expected  as  an  unavoidable 
process  of  Nature  and  believed  to  be  needful  for  healing, 
but  was  constantly  realized.  Hence  the  pus  was  called 
"laudable"  pus !  How  well  I  remember  forty  years  ago 
at  the  beginning  of  each  winter's  session  when  I  was  the 
assistant  of  the  late  Professor  Samuel  D.  Gross,  his  turn- 
ing to  the  orderly  and  saying  to  him,  "To-morrow, 
Hugh,  I  shall  lecture  on  suppuration.  Go  over  to  the 
hospital  in  the  morning  and  get  a  cupful  of  pus  for  my 
lecture."  Pus,  mark  you,  was  always  "on  tap,"  so  to 
speak,  though  the  little  hospital  contained  only  a  dozen 
beds ! 

1.   In  this  article  I  use  the  word  antiseptic  as  the  more  popular 
one  to  include  also  the  aseptic  method. 


Perhaps  the  best  way  to  give  the  reader  an  idea  of 
wound  conditions  at  that  time  will  be  to  describe  an 
ordinary  operation  and. its  results.  We  will  suppose  that 
it  is  an  amputation.  The  surgeon  approached  the  opera- 
tion with  the  clean  hands  of  a  gentleman.  He  usually 
wore  an  old  coat  covered  with  dried  blood  spots  from 
previous  service.  His  finger-nails  very  likely  were  long 
and  no  special  attention  was  given  to  them.  The  instru- 
ments were  taken  out  of  a  velvet-lined  case  and  were 
as  clean  as  ordinary  table-knives  would  be.  The  opera- 
tion was  done  without  any  preliminary  cleansing  of  the 
skin  other  than  to  remove  any  visible  dirt.  If  the  knife 
happened  to  fall  on  the  floor  it  was  picked  up,  rinsed  in 
a  basin  of  ordinary  water  and  used  as  it  was.  The 
marine  sponges  then  always  used  were  washed  clean  in 
ordinary  water  and  used  over  and  over  again  even  after 
being  saturated  with  foul  pus.  The  blood-vessels  were 
tied  with  ordinary  silk ;  one  end  was  cut  short,  the  other 
one  hung  out  of  the  wound.  After  an  amputation  of  a 
fleshy  thigh  I  have  often  seen  25  or  30  such  "ligatures," 
as  they  are  called,  gathered  into  two  bundles,  one  at  each 
end  of  the  wound.  The  flaps  were  then  sewed  together 
with  an  ordinary  needle  and  thread  and  the  stump 
dressed  first  with  an  old  rag  (which,  however,  would  be 
ordinarily  clean)  or  scraped  lint  spread  with  some  sim- 
ple grease.  Over  that  would  be  placed  some  other  rags, 
lint,  cotton,  or  other  dressing,  and  .finally  a  bandage. 
During  the  Civil  War  these  greasy  dressings  gave  place 
to  simple  cold-water  dressings. 

By  the  second  day  the  patient  would  begin  to  have 
considerable  fever.  By  the  third  or  fourth  the  tempera- 
ture would  rise  to  what  we  now  know  (for  medical  ther- 
mometers were  not  in  general  use  in  that  early  day!)  to 
about  103,  104  or  105  F.  Then  we  would  poultice  the 
wound.  Every  few  hours  the  patient  would  be  disturbed, 
a  new  poultice  put  on  to  replace  the  old  one,  now  cold, 
i'oul  and  ill-smelling,  and  by  this  time  bathed  with  pus. 
T  have  often  seen  the  pus  escaping  by  the  tablespoon- 
ful  and  the  wounds  alive  with  squirming  maggots 
resembling  chestnut  worms.  By  this  time  also  it  was 
hoped  that  the  silk  ligatures,  with  which  the  arteries 
had  been  tied,  had  literally  "rotted"  loose  and  each  one 
of  them  was  gently  pulled  on  to  the  discomfort  of  the 
patient.  Care  was  taken  that  the  ligatures  with  knots 
tied  on  them  (in  order  to  distinguish  those  that  secured 
the  large  blood-vessels)  should  not  be  pulled  on  severely 


until  probably  the  tenth  or  twelfth  day.  Meantime  the 
patient  was  tossing  about  the  bed  with  pain,  with  thirst, 
without  appetite,  without,  sleep  except  such  as  morphin 
would  secure.  This  at  the  same  time  dried  up  all  the 
secretions,  producing  constipation  and  other  evils. 

By  about  the  tenth  to  the  fourteenth  day,  suppura- 
tion having  been  fully  established  and  quantities  of  pus 
pouring  from  the  wound,  the  fever  would  subside  and 
the  wound  would  begin  slowly  to  heal.  Of  course,  the 
healing  could  not  be  complete  so  long  as  the  silk  liga- 
tures were  still  protruding  from  the  wound.  Sometimes 
they  did  not  become  detached  for  even  months  or  years, 
but  more  commonly  all  of  them  would  rot  loose  in  from 
ten  days  to  three  weeks.  When  the  silk  ligatures  on  the 
large  blood-vessels  came  away,  if  the  healing  process 
had  formed  in  the  blood-vessels  a  firm  clot,  which  had 
become  adherent,  and,  so  to  speak,  "corked"  it  up,  all 
went  well.  But,  as  very  frequently  happened,  when  the 
ligature  and  the  rotten  end  of  the  artery  were  pulled  off 
and  there  was  no  clot  to  act  as  a  stopper,  "secondary2 
hemorrhage"  followed.  This  often  came  on  after  the 
patient's  wound  had  been  dressed  and  the  surgeon  had 
left,  and,  if  so,  very  likely  the  first  notice  that  the  nurse 
had  that  anything  was  wrong  would  either  be  the  gasping 
for  breath  of  the  patient  or  his  moans  and  cries,  or  some- 
times by  the  blood  which  had  not  only  saturated  the  mat- 
tress, but  had  even  appeared  in  a  pool  on  the  floor. 
How  fatal  were  such  hemorrhages  may  be  seen  from  the 
fact  that  in*  2,235  cases  of  hemorrhage  in  the  Civil  War 
61.7  per  cent,  of  the  patients  died.3 

I  shall  never  forget  one  night  about  ten  days  after  the 
battle  of  Gettysburg,  when  it  was  my  business  as  "officer 
of  the  day"  to  attend  to  all  emergency  cases.  That  night 
I  was  called  to  five  cases  of  secondary  hemorrhage.  To 
indicate  what  a  difference  there  is  between  modern  and 
ancient  conditions,  in  the  thirty-four  years  since  October, 
1876,  when  I  began  the  practice  of  the  antiseptic 
method,  I  have  not  seen  as  many  cases  of  secondary 
hemorrhage  as  I  treated  in  that  one  night. 

It  was  a  rare  thing  for  any  patient  after  such  an  oper- 
ation to  get  well  under  three  or  four  weeks,  and  it  was 
not  uncommon  for  healing  to  be  delayed  for  three  or 

2.  So    called    to    distinguish    it    from    "primary    hemorrhage," 

i.   e.   the   bleeding   occurring   at  time  of  the   accident  or   operation. 

3.  Med.  and  Surg.  Hist.  War  of  the  Rebellion,  Part  3,  Surg. 
Vol.,   p.   765. 


6 

four  months,  so  that,  in  spite  of  the  great  mortality,  the 
wards  of  the  hospitals  were  cumbered  with  convalescent 
patients.  The  rare  case  in  which  healing  took  place  by 
"first  intention/'  i.  e.,  at  once,  was  recounted  as  a  tri- 
umph. To-day  it  is  precisely  the  reverse.  The  case  in 
which  healing  does  not  occur  primarily  and  at  once  is 
regarded  as  a  disaster. 

But  a  prolonged  convalescence  was  the  least  of  the 
evils  to  which  a  patient  was  subject.  A  large  majority 
of  the  wounds  were  followed  by  erysipelas,  by  lockjaw, 
or  by  blood  poisoning,  and  hospital  gangrene  sometimes 
became  a  veritable  plague.  Gangrene  in  various  forms 
during  the  Civil  War  was  rife  and  often  fatal.  In  2,503 
cases  1,1*42  patients  died,  a  mortality  of  45.6  per  cent.4 
In  one  variety  which  was  frequent,  hospital  gangrene,  a 
simple  flesh  wound  scarcely  larger  than  the  bullet  which 
made  it,  became  larger  and  larger  till  a  hand  would 
scarcely  cover  it  and  it  would  eat  into  the  tissues  until 
one  could  put  half  his  fist  into  the  sloughing  cavity. 

Of  505  cases  of  lockjaw  (tetanus),  451  were  fatal,  a 
mortality  of  89.3  per  cent.5  Pyemia  or  blood  poisoning 
was  terribly  frequent  and  almost  as  fatal  as  it  was  fre- 
quent, for  of  2,818  cases  in  the  Civil  War  2,747  patients 
died,  or  97.4  per  cent  !6  When  a  joint  was  opened  or 
wounded,  the  result  was  frequently  either  amputation 
or  death,  or  not  uncommonly  amputation  and.  death. 
Of  2,382  wounds  of  the  knee-joint  alone  for  which 
amputation  was  performed  1,212  patients  died,  a  mor- 
tality of  51  per  cent.,  and  of  973  similar  wounds  for 
which  amputation  was  not  performed  591,  or  61  per  cent, 
of  the  patients  died.7 

Fractures,  as  most  people  know,  are  divided  into  two 
kinds:  simple  fractures  in  which  the  skin  is  unbroken, 
and  compound  fractures  in  which  the  broken  bone  pro- 
trudes through  the  skin.  Simple  fractures  nearly  always 
heal  with  relatively  little  pain  and  slight  fever;  but  in 
the  preantiseptic  days  when  the  skin  was  broken  and  the 
bone  protruded  two  out  of  three  patients  with  these 
compound  fractures  were  sure  to  die. 

Moreover,  certain  regions  of  the  body  were  forbidden 
ground  unless  the  surgeon  were  absolutely  compelled  to 
invade  them.     "No  one  would  open  the  head  if  he  could 

4.  Ibid.,  p.   824. 

5.  Ibid.,  p.  819. 

6.  Ibid.,    p.   858. 

7.  Ibid.,   p.   367. 


possibly  avoid  it.  No  one  would  dare  to  make  an  inci- 
sion through  the  abdominal  wall  into  the  cavity  of  the 
abdomen  unless  a  bullet  or  a  dirk  had  gone  before  him 
and  opened  the  way.  The  reason  for  our  hesitation  was 
that  death  stalked  behind  us. 

How  eloquent  is  the  statement  of  Sir  Samuel  Wilks,8 
that  "the  change  came  home  to  me  in  an  almost 
startling  manner  from  what  I  witnessed  in  the  post- 
mortem room.  Some  time  before  [i.  e.,  before  Lister's 
discoveries],  when  reading  a  paper  on  pyemia  (blood 
poisoning),  I  had  no  difficulty  in  collecting  100  cases 
which  had  occurred  within  a  very  short  time  previously, 
when  suddenly  this  terrible  malady  disappeared — it  was 
gone  never  to  return."  So,  too,  lockjaw  (tetanus), 
except  in  accidental  cuts  that  have  been  neglected  and 
have  not  received  proper  surgical  care,  has  almost  com- 
pletely disappeared.  Again,  at  the  present  day  one  prac- 
tically never  sees  erysipelas  after  operations;  and  in 
order  to  find  illustrations  of  hospital  gangrene  to  show 
to  my  classes  for  the  last  thirty  years  I  have  had  to  rely 
on  pictures  from  the  Surgical  History  of  the  Civil  War 
and  other  similar  sources,  for  I  have  not  seen  a  single 
case  in  private  or  hospital  practice  since  I  first  adopted 
the  antiseptic  method  in  1876. 

II.    THE   DISCOVERY   AND  DEVELOPMENT   OF  THE 
ANTISEPTIC    METHOD9 

Neither  time  nor  space  will  allow  me  to  describe  the 
many  earlier  steps.  Schwann,  in  1837,  in  studying 
putrefaction,  reached  the  conclusion  that  it  was  not  the 
gases  of  the  air,  especially  the  oxygen,  as  was  then  uni- 
versally believed,  that  caused  putrefaction,  but  organic 
particles  which  floated  in  the  air  and  which  could  be 
destroyed  by  heat.  In  1854  Schroder  and  Dusch  showed 
that  putrefaction  did  not  occur  in  organic  fluids  in 
flasks  if  the  air  entering  the  flasks  was  simply  filtered 
through  cotton  wool.  Pasteur,  in  1864,  showed  that  it 
was  necessary  neither  to  heat  the  air  nor  thus  to  filter  it, 
for  if  the  air  merely  entered  through  a  tortuous  tube  in 
which  the  dust  could  settle  before  it  reached  the  fluid 

8.  Royal   Com.   on  Vivisection,   1907-08.   Q.   7.750. 

9.  See  Lord  Lister's  Collected  Papers,  Oxford,  1909  (later  ref- 
erence to  these  Collected  Papers  will  be  indicated  simply  by  "Lister, 
vol.  — ,  p.  — ),"  Brit.  Med.  Jour.,  Dec.  13,  1902.  The  Lister  number 
celebrating  the  fiftieth  anniversary  of  his  receiving  his  degree,  and 
Lister's  Huxley  Lecture  in  the  same  journal,  Oct.  6,  1900,  and 
Cameron's  "Lister  and  the  Evolution  of  Wound  Treatment,  etc.," 
Glasgow,   1907. 


no  change  took  place  in  the  fluid,  or  if  flasks  containing 
a  material  which  would  putrefy  were  left  open  in  a  place 
where  the  air  had  been  undisturbed  sufficiently  long  to 
allow  the  dust  to  settle,  as,  for  example,  in  a  cellar,  no 
decomposition  took  place  and  no  growth  appeared  in 
such  fluids. 

Lister  naturally  was  profoundly  impressed  by  these 
studies  of  Pasteur  and  he  proceeded  to  make  many 
experiments  to  confirm  or  disprove  them.  Among  them 
I  will  only  relate  the  following:10  Lister  filled  four 
glass  flasks  one-third  full  of  urine  and  drew  out  the 
neck  of  each  flask  with  a  spirit  lamp  into  a  tube  less  than 
one-twelfth  of  an  inch  in  diameter.  Three  of  these  long 
open  tubes  were  then  bent  at  various  angles  downward, 
while  the  fourth,  equally  narrow,  was  left  short  and  ver- 
tical. Each  flask  was  then  boiled  for  five  minutes,  after 
which  they  were  left  with  the  ends  of  the  small  necks 
still  open.  Through  these  open  mouths  the  air. 
including  its  ox}rgen,  would  pass  out  during  the  heat 
of  the  day  and  pass  in  during  the  colder  night.  The 
boiling  was  to  kill  any  organisms  in  the  liquid  or 
on  the  sides  of  the  glass.  The  object  of  the  bending 
of  the  three  necks  downward  was  to  allow  the  air  to 
pass  in  and  out,  but  to  intercept  the  particles  of 
dust,  which,  according  to  the  germ  theory,  caused 
putrefaction.  The  germs,  being  heavier  than  air,  could 
not  rise  in  the  bent  necks.  The  fourth  neck,  however, 
being  short  and  vertical,  not  only  allowed  the  air  to  pass 
in  and  out,  but  gave  a  very  narrow  but  real  opportunity 
for  dust  and  germs  to  fall  into  the  liquid.  If  any  of 
these  were  living  organisms  they  could  produce  putrefac- 
tion. In  a  short  time  the  vessel  with  the  short  and  ver- 
tical neck  showed  growths  of  mold  and  the  liquid 
changed  its  color,  showing  chemical  changes;  but  in  the 
three  flasks  with  bent  necks  the  urine  after  four  years 
icas  entirely  unaltered.  A  year  after  the  commencement 
of  the  experiment  a  little  of  the  urine  in  one  of  the  flasks 
with  a  bent  neck  was  poured  into  a  wine-glass ;  it  had  not 
lost  its  original  acidity  and  normal  odor  and  a  micro- 
scope showed  not  the  minutest  organism.  In  two  days 
it  was  most  offensive,  and  under  the  microscope  already 
teemed  with  organisms.  The  other  three  flasks  were 
subjected  to  a  further  severe  and  rather  amusing  test. 
Two  years  after  the  beginning  of  the  experiment  Lister 

10.   Lister:    ii,    173;    Brit.   Med.   Jour.,    1871,    ii,    225. 


9 

had  to  transport  them  from  Glasgow  to  Edinburgh  on 
the  railway  when  he  was  appointed  to  the  chair  of  sur- 
gery in  Edinburgh.  He  took  charge  of  these  flasks  him- 
self, "nursing  them  carefully/'  as  he  says,  "to  the  amuse- 
ment of  my  fellow  travelers."  In  the  drive  from  the 
station  to  his  house  the  violent  rocking  of  the  carriage 
churned  up  the  contents  of  the  flasks  till  the  upper  part 
was  full  of  a  frothy  mixture  of  this  proved  putrescible 
liquid  with  the  atmospheric  gases;  yet  after  two  years 
more  no  decomposition  had  taken  place. 

The  explanation  of  this  convincing  experiment  was 
simply  this :  The  germs  in  the  atmosphere  could  not 
rise  against  gravity  in  any  of  these  tubes  bent  downward 
and  so  could  not  gain  access  to  the  urine.  This  easily 
preserved  a  decomposable  fluid  for  four  years,  although 
the  air  passed  in  and  out  freely  every  day.  But  the 
urine  in  the  flask  with  the  straight  but  very  narrow  neck 
in  a  few  days  had  undergone  decomposition.  The  only 
difference  between  the  flasks  was  that  the  three  bent 
tubes  prevented  the  entrance  of  the  germs,  though  not  of 
oxygen  or  other  constituent  of  the  air,  while  the  straight 
but  equally  narrow  tube  allowed  the  germs  to  enter 
through  in  very  small  quantities,  and  yet  these  few  grew 
and  produced  putrefaction. 

In  order  still  further  to  confirm  this  experiment, 
however,  Lister  tested  these  bent  tubes  by  the  condensed 
beam  of  light  which  Tyndall  had  used  and  found  that 
they  were  optically  empty.11 

These  experiments  convinced  him  that  it  was  not  the 
oxygen  or  any  other  gas  in  the  air  that  caused  inflam- 
mation and  suppuration,  but  that  these  were  caused  b}r 
the  minute  organisms  suspended  in  the  air.  In  dressing 
a  wound,  then,  the  problem  was  how  to  exclude  not  the 
air  or  its  oxygen,  which  was  impossible,  but  how  to 
exclude  the  organisms  in  the  air.  This  could  be  done 
by  applying  a  dressing  saturated  with  some  material 
capable  of  destroying  the  life  of  these  germs.  This  was- 
the  basis  of  the  antiseptic  method.12  It  must  be  remem- 
bered that  at  that  time  we  were  wholly  ignorant  of  what 
now  everybody  knows,  that  there  are  hundreds  of  differ- 
ent kinds  of  germs  or  bacteria.  Even  the  greatest  scien- 
tists were  then  groping  in  the  dark  seeking  for  the  light 
by  observation  and  especially  by  experiment. 

11.  See  Tyndall's  charming  lecture  on  Dust  and  Disease,  in  Frag- 
ments of  Science,  1871,  p.  275.     Appleton  &  Co. 

12.  Lister:  ii,  37;  Brit.  Med.  Jour.,  1867,  ii,  246. 


10 

About  that  time  Lister  was  much  struck  with  an 
account  of  the  effect  of  mingling  phenol  (carbolic  acid) 
with  the  sewage  of  the  town  of  Carlisle,  England.13  He 
proceeded,  therefore,  to  experiment  with  it  in  compound 
fractures.  I  have  already  stated  how  fatal  a  compound 
fracture  was  in  those  days.  Indeed,  Mr.  Syme,  the  great 
Edinburgh  surgeon,  predecessor  and  father-in-law  of 
Lister,  was  inclined  to  think  that,  on  the  whole,  "it 
would  be  better  if  in  every  case  of  compound  frac- 
ture of  the  leg  amputation  were  done  without  any 
attempt  to  save  the  limb."  The  marked  success  which 
followed  his  dressing  these  compound  fractures13, 14 
with  carbolic  acid  led  him  then  to  experiment  with  its 
use  in  abscesses.13- 14> 15  This  was  followed  again  by  such 
remarkable  success  that  he  was  led  to  try  it  in  accidental 
wounds  and  finally  to  intentional  and  extensive  wounds, 
i.  e.,  surgical  operations.16 

Practically  the  progressive  introduction  of  the  anti- 
septic system  from  compound  fractures  up  to  deliberate 
surgical  operations  was  one  vast  experiment  in  the 
human  living  body — an  experiment  justified,  as  all  the 
world  well  knows,  by  its  splendid  and  continuing  results. 
Yet  when  in  1880  or  1881  Lister  wished  to  make  addi- 
tional experiments  on  animals  to  perfect  his  method  still 
further,  so  stringent  was  the  law  in  England  that  he  was 
obliged  to  go  to  the  Veterinary  School  at  Toulouse. 
France.17 

Like  many  surgeons,  Lister  had  noticed  the  fact  that 
a  needle  or  a  bit  of  glass  would  often  lie  for  an  indefinite 
period  in  the  body  without  producing  inflammation  or 
pus,  but  that  a  bit  of  silk  or  linen  thread  was  sure  to 
produce  pus.  He  believed  the  reason  was  that  the 
thread  was  porous  and  that  its  interstices  contained 
these  germs  which  no  one  had  then  seen  and  identified, 
and  that  they  gave  rise  to  decomposition  and  produced 
the  pus.  So,  Lister,  from  his  previous  experiments  with 
phenol  (carbolic  acid),  believed  that  if  the  thread  with 
which  an  artery  was  tied  were  steeped  in  phenol  and 
both  the  ends  of  the  silk  were  cut  short  it  might  be  left 
in  the  wound  without  producing  any  inflammation  or 

13.  Lister  :  ii,  3  ;  Lancet,  1867.  i,  326.  357.  387,  507  ;  ii,  95. 

14.  Lister,  ii,  3,  32,  37  :  Brit.  Med.  Jour.,  1867,  ii,  246. 

15.  Lister,  ii,  32,  36,  42  ;  Brit.  Med.  Jour.,  1867,  ii,  246. 

16.  Lister,  ii,  188,  199,  256,  etc. ;  Brit.  Med.  Jour.,  1871,  ii,  225  ; 
Edinburgh  Med.  Jour.,  1871-2,  xvii,  144 ;  Edinburgh  Med.  Jour.. 
1875-6,    xxi,    193,    481. 

17.  Lister,  ii,  281  ;  Lancet,  1881,  ii,  863,  901  ;  Tr.  Interhat.  Med. 
Cong.,   London,   1881,   ii,   369. 


11 

suppuration.  The  wound  could  then  be  closed  at  once — 
an  immense  gain,  for  it  would  heal  at  once.  "Before 
applying  these  principles  on  the  human  subject,"  he  says, 
"I  though  it  right  to  test  them  on  one  of  the  lower  ani- 
mals."18 Accordingly,  Dec.  12,  1867,  he  tied  the  great 
blood-vessel  in  the  neck  of  a  horse,  having  steeped  the 
silk  for  some  time  in  a  solution  of  phenol.  Both  ends 
were  cut  short,  the  wound  was  entirely  sewed  up  and 
treated  with  phenol  dressings.  Ten  days  after  the  opera- 
tion the  dressings  were  removed,  the  wound  was  healed, 
and  there  was  no  pus !  Thirty-nine  days  after  the  opera- 
tion he  carefully  examined  the  artery  which  he  had  tied. 
The  operation  was  a  complete  success,  the  blood  current 
had  been  entirely  arrested  and  the  thread  had  been  cov- 
ered in  by  dense  fibrous  tissue.  Thus  encouraged,  he 
says :  "I  felt  justified  in  carrying  a  similar  practice 
into  human  surgery.''19  Jan.  29,  1868,20  he  saw  a 
woman,  51  years  old,  with  an  aneurism  as  large  as  a 
large  orange  in  the  upper  part  of  the  left  thigh.  (An 
aneurism,  I  should  explain,  is  a  dilated  portion  of  an 
artery,  the  yielding  of  the  wall  being  due  to  disease  of 
the  wall  of  the  blood-vessel.  This  dilatation  continues 
to  increase  in  size  till  finally  the  wall  of  the  artery  is  so 
thin  that  it  bursts  and  the  patient  dies  from  hemor- 
rhage.) On  the  following  day  he  tied  the  woman's 
artery  with  a  piece  of  silk  which  had  been  steeped  for 
two  hours  in  phenol. 

The  wound  was  treated  like  that  in  the  horse's  neck, 
i.  e.,  both  ends  of  the  ligature  were  cut  short,  the  wound 
again  entirely  closed  and  a  phenol  dressing  applied.  The 
patient  was  immediately  relieved  of  the  pain  she  had 
previously  experienced;  she  had  no  fever,  the  pulse  was 
practically  normal  the  entire  time,  and  "her  appetite, 
which  had  been  absent  during  the  four  weeks  of  agony 
that  preceded  the  operation,  returned  two  days  after 
it."21  She  made  a  perfect  recovery.  November  30,  ten 
months  after  the  operation,  she  suddenly  expired.  For- 
tunately, Lister  himself  had  the  opportunity  of  making 
the  post-mortem.  He  found  that  her  death  was  due  to 
the  bursting  of  a  similar  aneurism  inside  of  the  chest. 
Examining  the  artery  which  he  had  tied,  he  found  that 

18.  Lister,  ii,  63;  Lancet,  1867,  ii,  668. 

19.  Lister,  ii,  65  ;  Lancet,  1867,  ii,  668. 

20.  Lister   ii,   88;   Lancet,   1869,   i,  451. 

21.  Lister,  ii,  89  ;  Lancet,  1869,  i,  451. 


12 

the  silk  had  almost  all  disappeared,  but  that  there  was  a 
little  fluid  around  the  remnant  of  the  ligature,  which 
probably  would  have  developed  into  a  small  abscess  and 
might  have  caused  great  mischief  had  she  lived  longer. 
This,  therefore,  suggested  to  him  the  expediency  of  sub- 
stituting for  the  silk  some  other  substance  which  would 
be  more  readily  absorbed.21 

In  Philadelphia  years  before  Dr.  Physick  had  already 
tried  animal  ligatures  made  of  buckskin,  Dorsey  those  of 
kid,  Hartshorn  had  used  parchment,  and  Bellenger  and 
Eve  the  tendon  of  the  deer,  but  for  various  reasons  these 
had  all  been  abandoned.  Lister  determined  to  try  cat- 
gut. Although  he  had  great  confidence  in  the  use  of 
catgut  steeped  in  a  solution  of  phenol,  yet  he  says22  "in 
order  to  put  the  antiseptic  animal  ligature  to  the  test, 
I  made  the  following  experiment,"  for  only  by  experi- 
ment in  an  actual  living  body  of  animal  or  man  could 
the  question  whether  it  was  actually  safe  or  not  be  surely 
answered.  Dec.  31,  1868,  he  tied  the  right  carotid 
artery  in  the  neck  of  a  healthy  calf  at  several  places  with 
different  kinds  of  animal  ligature,  including  catgut. 
All  were  cut  short  except  one  end  of  the  catgut,  which 
was  purposely  left  three-quarters  of  an  inch  long  to 
determine  what  would  become  of  this  foreign  material. 
The  wound  was  completely  closed  and  dressed.  After 
ten  days  the  dressings  were  removed  and  the  wound 
found  quite  dry.  Thirty  days  after  the  operation  Lister 
says,  on  dissection,  he  was  struck  with  the  entire  absence 
of  any  infection  or  inflammatory  thickening  in  the 
vicinity  of  the  blood-vessel.  On  exposing  the  artery 
itself  he  was  greatly  disappointed  at  first  to  find  the 
ligature  to  all  appearance  still  there  and  as  large  as  ever. 
On  more  careful  examination,  however,  he  found  that 
this  apparent  ligature  was  not  the  catgut  ligature  at  all, 
but  that  this  ligature  had  been  transformed  into  bands 
of  living  tissue,  making  the  artery  not  weaker,  as  silk 
often  did,  but  stronger  than  ever  at  the  point  where  it 
was  tied.  The  knots  had  disappeared  and  also  the  three- 
quarters  inch  of  catgut  purposely  left.  Everything  had 
oeen  absorbed. 

Even  one  not  a  surgeon  can  see  what  an  enormous  dif- 
ference in  rapidity  of  healing  without  inflammation,  pain 
or  other  serious  disturbance  of  the  body  this  use  of  cat- 
gut with   immediate  total  closure  and  healing  of  the 

22.  Lister,  ii,  93  ;  Lancet,  1869,  i,  451. 


13 

wound  provided.  Before  Lister,  the  old  ligatures  hang- 
ing out  in  bundles  were  always  inviting  infection,  sup- 
puration, erysipelas,  lockjaw,  blood-poisoning,  hospital 
gangrene  and  death.  Xo  patient  was  absolutely  safe 
till  the  wound  was  absolutely  healed  and  this  often 
required  weeks  or  months.  With  the  catgut  ligature, 
both  ends  being  cut  short,  the  wound  closed  at  once, 
and,  the  ligature  being  absorbed,  the  wound  healed 
in  less  than  a  week,  not  uncommonly  in  three  or  four 
days,  with  little,  if  any,  immediate  suffering  and  with- 
out any  ultimate  danger  of  those  many  serious  com- 
plications above  mentioned.  But  no  one  not  a  sur- 
geon can  appreciate  to  the  full  the  meaning  of  these 
brief  words.  While  the  patient  made  a  smooth  and 
speedy  recovery  without  complications,  the  surgeon  slept 
the  uninterrupted  sleep  of  the  just,  secure  against 
wearing  anxiety  on  account  of  sudden  hemorrhage  or 
insidious  infection.  The  heart-breaking  tragedies  which 
often  made  the  surgeon  wish  he  were  a  hod-carrier  ot 
even  in  his  grave  are  now  but  specters  of  a  horrid  past. 

As  I  have  said,  we  had  no  idea  at  first  of  the  enormous 
variety  and  different  characters  of  the  germs.  In  his 
early  studies  on  putrefaction,  Lister  spoke  of  them  in  a 
general  way  as  "germs,"  because  the  various  species  of 
plants  (for  they  are  plants  and  not  animalculas)  had  not 
been  distinguished.  Xow  there  are  scores  and  even  hun- 
dreds of  known  varieties.  Many  of  these  simply  cause 
putrefaction  or  decomposition  and  are  not  in  themselves 
capable  of  giving  origin  to  any  particular  disease.  Other 
varieties,  each  one  of  which  causes  a  special  disease  and 
can  cause  no  other  disease,  have  been  isolated  and  iden- 
tified. Some  of  these  germs  cause  medical  diseases, 
with  which  I  have  nothing  to  do  here.  The  germs  of 
lockjaw,  tuberculosis,  anthrax  (wool  sorters'  disease), 
erysipelas,  glanders,  etc.,  are  among  the  most  virulent 
foes  with  which  the  surgeon  has  to  contend. 

How  have  these  been  identified  and  how  do  we  prevent 
their  entrance  into  the  system  of  the  patient?  The 
process  is  very  simple  to  describe,  but  very  complicated 
and  difficult  practically.  Let  us  take  the  case  of  lock- 
jaw for  instance.  A  peculiar  kind  of  germ,  looking  a 
good  deal  like  a  tack  with  a  straight  body  and  a  large 
head  at  one  end.  was  discovered  by  animal  experiments 
by   Xicolaier  in   earth   and   dust   in    1884. 23     In    1880 

23.  Deutsch.  med.  Wchnschr.,  1884,  No.  52,  p.  842. 


14 

Kitasato,  the  Japanese  bacteriologist,24  first  obtained  it 
in  pure  culture,  former  experimenters  having  failed 
because  they  did  not  know  that  it  only  grows  well  when 
oxygen  is  excluded. 

But  how  do  we  know  that  this  tack-like  germ  and  it 
alone  is  the  cause  of  lockjaw? 

First,  in  a  patient  ill  with  lockjaw,  this  particular 
bacillus  or  germ  must  be  discovered. 

Second,  a  pure  culture  of  it  must  be  produced ;  that  is 
to  say,  the  tetanus  bacillus  must  be  separated  from  all 
other  germs  and  cultivated  by  itself.  Third,  some  of 
this  pure  culture  of  tetanus  unmixed  with  any  other 
germs  whatever  must  be  injected  into  an  animal  to  see 
point-blank  whether  this  particular  bacillus  will  produce 
lockjaw.  Fourth,  from  the  body  of  this  animal  the  same 
germ  that  was  injected  must  be  recovered.  Fifth,  with 
a  pure  culture  of  this  recovered  bacillus  the  cycle  must 
be  begun  over  again  and  completed  sufficiently  fre- 
quently to  assure  the  experimenter  that  the  connection 
between  the  disease  and  the  germ  is  not  accidental,  but 
essential  and  invariable.  Sixth,  no  other  germ  used  in 
the  same  way  must  produce  lockjaw. 

In  this  same  manner  the  germs  that  produce  inflam- 
mation and  suppuration,  which  are  the  ever-present 
danger  to  the  surgeon,  have  been  identified,  and  also, 
what  is  equally  important,  the  places  where  they  and 
many  others  exist.  In  this  way  we  have  determined  the 
fact  that,  while  there  are  some  in  the  air,  they  are  few  in 
number  and  so  constitute  a  small  though  a  real  danger. 
But  the  places  where  they  are  found  and  are  most  dan- 
gerous are  on  the  skin  and  clothing  of  the  patient,  the 
hands  of  the  surgeon  and  especially  under  his  finger 
nails  and  at  the  roots  of  his  nails,  on  instruments,  dress- 
ings, silk,  catgut,  and  other  things  used  for  ligatures; 
in  fact,  practically  every  material  that  one  can  think  of. 
We  know  now  how  all-pervading  they  are.  We  know, 
too,  that  phenol  (carbolic  acid),  corrosive  sublimate  and 
other  chemicals,  or  that  boiling  for  a  certain  time,  or 
heating  to  a  certain  degree  and  for  a  certain  time,  will 
kill  these  germs.  Thousands  of  such  painstaking 
researches  in  test-tubes  and  by  many  other  bacteriologic 
methods  have  been  carried  out  all  over  the  world  by  men 
either  wholly  unpaid,  working  for  the  love  of  truth  and 
love  of  their  fellow  creatures,  or  paid  but  meager  pit- 

24.   Deutsch.   med.   Wchnschr..   1889,   No.   31. 


15 

tauces.  Then  when  a  discovery  seems  to  have  been  made 
comes  the  needful,  the  finally  convincing,  the  unavoid- 
able experiment — in  a  living  body  itself.  The  only  ques- 
tion is  should  Lister  have  made  this  final  test  first  on  a 
horse  and  a  calf,  or  on  two  human  beings?  Can  any 
one  with  a  sane,  well-balanced  mind  hesitate  as  to  the 
answer  ? 

III.    THE  RESULTS 

The  results  of  the  establishment  of  the  antiseptic 
method  have  been  so  extraordinary  as  to  be  incredible 
were  it  not  for  ample  testimony  the  world  over.  They 
have  been  already  stated  in  part,  but  a  few  words  more 
must  be  added. 

At  present  before  an  operation  is  begun  the  patient's 
skin,  the  surgeons'  and  the  nurses'  hands  are  scrupu- 
lously disinfected,  sterile  gloves  are  usually  worn  and 
every  person  is  clothed  in  a  disinfected  gown.  The 
instruments,  dressings,  ligatures,  everything  that  is  to 
come  in  contact  with  the  wound,  is  carefully  disin- 
fected. Disinfected  gauze  "sponges"  are  used  once  and 
then  discarded. 

It  is  almost  impossible  for  any  one  not  a  surgeon  to 
understand  how  different  are  the  results  from  this  radi- 
cal change  of  methods.  No  change  of  climate  from 
fierce  mid-winter  storms  to  lovely  summer  breezes  or 
autumn  golden  harvest  could  be  greater.  Most  wounds 
now  heal  within  a  few  days,  one  might  almost  say  with- 
out the  patient's  being  sick.  Compound  fractures  and 
opened  joints  heal  as  if  there  had  been  no  break  in  the 
skin.  Arteries  can  be  tied  anywhere  without  fear  of 
secondary  hemorrhage.  The  abdomen  is  now  fearlessly 
opened. 

A  woman  with  an  ovarian  tumor  no  longer  has  an 
operation  postponed  until  it  is  very  dangerous  but 
inevitable,  but  by  early  operation  is  relieved  almost  with- 
out danger,  even  from  tumors  so  large  as  to  weigh  twice 
as  much  as  the  patient  herself.  When  I  was  assistant  to 
Dr.  Washington  Atiee  in  the  late  sixties,  before  the  anti- 
septic period,  two  out  of  three  of  his  ovariotomy  patients 
died,  yet  he  was  the  then  most  famous  operator  in 
America.  ISTow  any  surgeon  who  loses  more  than  five 
out  of  100  is  looked  at  askance  by  his  colleagues,  and 
many,  many  hundreds  of  cases  have  been  operated  on 
with  a  mortality  falling  even  below  1  per  cent.  There 
is  not  an  organ  in  the  abdomen  that  has  not  been 
attacked;  organs  which  formerly  when  diseased  could 


1G 

net  be  touched  because  death  was  almost  sure  to  follow 
are  now  operated  on  every  day.  In  fact  as  I  once 
described  it,  the  abdominal  cavity  is  almost  the  surgeon's 
play-ground !  The  stomach,  the  intestines,  the  liver,  the 
gall  bladder,  the  pancreas,  the  spleen,  the  kidney,  every 
organ  is  operated  on,  and  with  extraordinary  success. 
Did  space  permit,  a  more  detailed  statement  could  be 
given,  but  it  could  scarcely  be  more  convincing. 

In  obstetrics  the  same  happy  results  have  followed  the 
introduction  of  the  antiseptic  method.  Puerperal  or 
child-bed  fever,  which  not  uncommonly  used  to  kill  one- 
half  or  two-thirds  or  even  three-fourths  of  the  women  in 
the  maternity  wards  of  a  hospital,  now  is  practically 
unknown  except  in  the  neglected  cases  brought  into  the 
hospital  at  a  late  date,  and  the  preantiseptic  general 
mortality  in.  maternity  cases  has  been  reduced  from  10 
per  cent,  or  more  to  1  per  cent,  and  less.  Brain  tumors, 
abscesses  and  other  diseases  of  the  brain  formerly  inevit- 
ably caused  death,  for  we  never  dared  to  touch  them. 
ISTow  the  number  of  recoveries  is  very  large.  Compound 
fractures  now  have  a  mortality  of  2  or  1  per  cent,  or 
less,  instead  of  over  60  per  cent,  and  now  very  rarely 
require  amputation ;  and  amputations  formerly  followed 
by  death  in  one-half  the  cases  have  a  mortality  of  10  per 
cent,  or  less.  In  general,  both  the  soldier  and  the  sailor 
are  provided  with  the  first  aid  packet,  which  contains  an 
antiseptic  dressing.  This  has  enormously  diminished 
the  mortality  of  wounds  received  in  battle. 

Perhaps  no  better  evidence  of  the  value  of  the  anti- 
septic method  in  civil  life  can  be  adduced  than  the 
results  in  three  hospitals.  In  Munich25  the  General 
Hospital  was  excessively  unhealthy.  Blood  poisoning 
was  very  frequent  and  hospital  gangrene,  which  had 
appeared  in  1872,  had  become  annually  a  more  and  more 
frightful  scourge  until  1874,  when  80  per  cent,  of  all 
wounds  that  occurred  in  the  hospital,  whether  accidental 
or  inflicted  by  the  surgeon,  were  attacked  by  it !  At  the 
beginning  of  1875  Nussbaum  introduced  the  antiseptic- 
treatment.  From  then  on  till  Lister's  visit,  presumably 
in  the  summer  of  1875,  not  one  single  case  of  hospital 
gangrene  had  occurred  and  only  one  case  of  blood  poison- 
ing, and  that  a  doubtful  one.  Erysipelas  was  rare  and 
mild  instead  of  being  very  prevalent  and  severe,  and  the 
convalescent  wards,  which  formerly  had  been  filled  to 

25.  Lister,  ii,  248  ;  Brit.  Med.,  Jour.,  1875,  ii,  769. 


1? 

overflowing,  stood  practically  empty.  In  Halle/6  Volk- 
mann  was  operating  in  an  extremely  unhealthy  hospital 
in  small,  overcrowded  wards,  with  the  toilet  rooms  open- 
ing directly  into  them  and  a  large  drain  running  directly 
underneath.  It  was  so  bad  that  it  had  been  condemned 
to  demolition.  After  his  introduction  of  the  antiseptic 
method  in  1872,  no  single  patient  suffering  from  com- 
pound fracture  in  which  conservative  treatment  was 
attained  had  died  either  from  the  fracture  or  from  a 
necessary  amputation,  nor  was  there  a  single  death  from 
secondary  hemorrhage  or  gangrene.  No  case  of  blood 
poisoning  had  occurred  for  a  year  and  a  half,  though  60 
amputations  had  been  done.  Hospital  gangrene  had 
entirely  disappeared  and  erysipelas  was  extremely  rare 
and  mild. 

Perhaps,  however,  the  most  extraordinary  success  was 
obtained  by  Lister27  in  his  own  wards  in  Glasgow.  Lis- 
ter was  professor  of  surgery  in  Glasgow  from  March, 
1865,  till  the  autumn  of  1869,  but  in  that  brief  period 
he  introduced  measures  that  were  absolutely  revolution- 
ary. The  Eoyal  Hospital  in  Glasgow  was  overcrowded, 
and  in  some  parts  of  the  building  the  conditions  were 
so  frightful  that  the  wards  had  to  be  entirely  shut  up 
for  a  time.  Lister's  own  account  of  this  is  interesting. 
He  says : 

"A  crisis  of  this  kind  occurred  rather  more  than  two  years 
ago  in  the  other  male  accident  ward  on  the  ground  floor,  sepa- 
rated from  mine  merely  by  a  passage  twelve  feet  .broad,  where 
the  mortality  became  so  excessive  as  to  lead,  not  only  to  clos- 
ing the  ward,  but  to  an  investigation  into  the  cause  of  the  evil, 
which  was  presumed  to  be  some  foul  drain.  An  excavation 
made  with  this  view  disclosed  a  state  of  things  which  seemed 
to  explain  sufficiently  the  unhealthiness  that  had  so  long 
remained  a  mystery.  A  few  inches  below  the  surface  of  the 
ground,  on  a  level  with  the  floors  of  the  two  lowest  male  acci- 
dent wards,  with  only  the  basement  area,  four  feet  wide,  inter- 
vening, was  found  the  uppermost  tier  of  a  multitude  of  coffins, 
which  had  been  placed  there  at  the  time  of  the  cholera  epi- 
demic of  1849,  the  corpses  having  undergone  so  little  change  in 
the  interval  that  the  clothes  they  had  on  at  the  time  of  their 
hurried  burial  were  plainly  distinguishable.  The  wonder  now 
was,  not  that  these  wards  on  the  ground  floor  had  been 
unhealthy,  but  that  they  had  not  been  absolutely  pestilential. 
Yet  at  the  very  time  when  this  shocking  disclosure  was  being 
made,  I  was  able  to  state,  in  an  address  which  I  delivered  to 

26.  Lister,  ii,  250  ;  Brit.  Med.  Jour..  1875,  ii,  769. 

27.  Lister,   ii,   124  ;   Lancet,   1870,   i,   4.   40. 


18 

the  meeting  of  the  British  Medical  Association  in  Dublin28, 
that  during  the  previous  nine  months,  in  which  the  antiseptic 
system  bad  been  fairly  in  operation  in  my  wards,  not  a  single 
case  of  pyemia  [blood  poisoning],  erysipelas,  or  hospital  gan- 
grene had  occurred  in  them ;  and  this,  be  it  remembered,  not 
only  in  the  presence  of  conditions  likely  to  be  pernicious,  but 
at  a  time  when  the  unhealthiness  of  other  parts  of  the  same 
building  was  attracting  the  serious  and  anxious  attention  of 
the  managers.  Supposing  it  justifiable  to  institute  an  experi- 
ment on  such  a  subject,  it  would  be  hardly  possible  to  devise 
one  more  conclusive. 

Having  discovered  this  monstrous  evil,  the  managers  at  once 
did  all  in  their  power  to  correct  it.  .  .  .  But  besides  having 
along  one  of  its  sides  the  place  of  sepulture  above  alluded  to, 
one  end  of  the  building  is  coterminous  with  the  old  cathedral 
churchyard,  ...  in  which  the  system  of  "pit  burial"  of 
paupers  has  hitherto  prevailed.  I  saw  one  of  the  pits  some 
time  since.  .  .  .  The  pit,  which  was  standing  open  for  the 
reception  of  the  next  corpse,  emitted  a  horrid  stench  on  the 
removal  of  some  loose  boards  from  its  mouth.  Its  walls  were 
formed  on  three  sides  of  coffins  piled  one  upon  another  in  four 
tiers,  with  the  lateral  interstices  between  them  filled  with 
human  bones,  the  coffins  reaching  up  to  within  a  few  inches  of 
the  surface  of  the  ground.  This  was  in  a  place  immediately 
adjoining  the  patients'  airing  ground,  and  a  few  yards  only 
from  the  windows  of  the  surgical  wards!  And  the  pit  which  I 
inspected  seems  to  have  been  only  one  of  many  similar  recep- 
tacles, for  the  Lancet  of  September  25  contains  a  statement, 
copied  from  one  of  the  Glasgow  newspapers,  that  "the  Dean  of 
Guild  is  said  to  have  computed  that  five  thousand  bodies  were 
lying  in  pits,  holding  eighty  each,  in  a  state  of  decomposition, 
around  the  infirmary." 

When  to  all  this  is  added  the  fact  that  the  large  fever 
hospital  was  separated  from  the  surgical  hospital  by  only 
eight  feet,  that  Lister's  hospital  of  nearly  600  beds  was 
cramped  in  area  and  almost  always  full  to  overflowing, 
and  that  he  was  operating,  it  might  almost  be  said,  in  a 
charnal  house,  yet  that  those  wards  were  continuously 
and  conspicuously  healthy  and  enjoyed  for  "three  years 
immunity  from  the  ordinary  evils  of  surgical  hospitals 
under  circumstances  which  but  for  the  antiseptic  system 
were  specially  calculated  to  produce  them,"29  we  stand 
convinced  by  such  a  huge  unintentional  experiment  on 
man  himself. 

Were  not  results  such  as  these  sufficient  to  justify  the 
experiments  on  animals  as  related  by  Lister  himself  and 

28.  Lister,   ii,    45. 

29.  Lister,   ii.  126  ;   Lancet,  1870,   i,  4,  40. 


19 

here  quoted,  by  which  such  blessed  relief  has  been 
brought  to  mankind? 

What  was  seen  in  Glasgow  has  occurred  all  over  the 
world.  The  surgical  revolution  of  the  last  thirty  years 
is  the  most  momentous  in  the  entire  history  of  surgery. 
In  every  science — chemistry,-  engineering,  botany, 
physics,  electricity— the  era  of  precise  experiments  has 
been  the  era  when  enormous  and  constant  progress  has 
been  made.  Medicine  is  no  exception.  We  have  closely 
studied  disease  by  various  observational  methods,  and 
clinical  observation  for  two  thousand  years  had  slowly 
advanced  our  knowledge  up  to  a  certain  point.  Then 
experimental  research,  which  employed  methods  of  pre- 
cision, varying  conditions  at  will,  noting  the  different 
results,  and  multiplying  the  experiments  at  will  instead 
of  waiting,  it  might  even  be  years,  until  Nature's  second 
experiment  occurred,  began  its  work;  and  in  the  past 
thirty  years  experimental  research  has  produced  a  more 
fruitful  harvest  of  good  to  animals  and  to  mankind  than 
the  clinical  observation  during  thirty  preceding  cen- 
turies. 

But  we  are  far  from  having  attained  perfection.  In 
medicine  and  in  surgery  many  problems  of  disease  and 
death  are  still  awaiting  solution  and  can  only  be  solved 
by  the  experimental  method.  A  number  of  organs  in 
the  body  are  as  yet  inaccessible  and' others  have  func- 
tions of  which  we  know  little  or  nothing.  Many  opera- 
tions ought  to  be  bettered  in  method  and  in  results. 
The  causes  of  many  diseases,  such  as  cancer,  scarlet  fever, 
measles,  whooping-cough,  etc.,  are  as  yet  unknown.  To 
dispel  all  this  ignorance  and  discover  a  cure  for  all  these 
and  other  diseases  is  the  earnest  wish  of  wise  and 
humane  experimenters  the  world  over.  Shall  the  com- 
munity aid  these  humane  life-saving  efforts,  or  shall 
they  by  restrictive  legislation  call  a  halt  and  let  death 
slay  our  fellow  creatures  and  especially  our  dear  chil- 
dren ?  The  answer  is  clear.  It  will  never  be  other  than 
an  emphatic  no  to  the  latter  cruel  course. 

1729  Chestnut  Street. 


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AMERICAN    MEDICAL    ASSOCIATION 

535  NORTH  DEARBORN  STREET,  CHICAGO 


*>UKE  MED.  CENTER  LIB. 


HISTORICAL 
COLLECTION 


"NOSTRUMS  AND  QUACKERY" 

[Second   Edition] 

For  some  years  The  Journal  of  the  American  Medical  Association 
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Advertising  Specialists  Drug  Cures 

Cancer  Cures  Mail-Order  Concerns 

Consumption  Cures  Mechanical  Fakes 

Deafness  Cures  Medical  Institutes 

Asthma  Cures  Hair  Dyes 

Baby  Killers  Headache  Cures 

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Articles  on  the  Nostrum  Evil  and  Quacks.  Fully  Illustrated. 
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Conspiracy  Against  the  Freedom  of  the  Press,  Strictly  Confidential,  the 
Treatment  Accorded  Private  Letters  by  the  Nostrum  Manufacturers, 
Patent  Medicines  Under  the  Pure  Food  Law,  Peruna,  Swamp  Root,  etc. 
[fifth  enlarged  edition] 

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OUKE    MED,    CENTER    OB.- 
HISTORICAL    COU.EUIOH 


